U.S. patent number 10,842,456 [Application Number 16/163,357] was granted by the patent office on 2020-11-24 for tomosynthesis method and xray recording apparatus.
This patent grant is currently assigned to Siemens Healthcare GmbH. The grantee listed for this patent is Siemens Healthcare GmbH. Invention is credited to Alexander Gemmel, Gerhard Kleinszig, Bjorn Kreher, Benedict Swartman, Wei Wei, Markus Weiten, Qiao Yang.
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United States Patent |
10,842,456 |
Gemmel , et al. |
November 24, 2020 |
Tomosynthesis method and xray recording apparatus
Abstract
A method for determining an alignment between at least two bone
parts of an elongated bone system of a patient includes recording a
plurality of partially spatially overlapping projection images by a
recording system of an x-ray device during a translational movement
of the x-ray device or the recording system in a direction of or
parallel to a longitudinal axis of the bone system. Tomosynthesis
image data of the bone parts is reconstructed from the recorded
projection images, and an alignment angle between the at least two
bone parts is determined or estimated at least partially based on
the reconstructed tomosynthesis image data and/or the plurality of
projection images.
Inventors: |
Gemmel; Alexander (Erlangen,
DE), Kleinszig; Gerhard (Forchheim, DE),
Kreher; Bjorn (Brauningshof, DE), Swartman;
Benedict (Mannheim, DE), Wei; Wei (Forchheim,
DE), Weiten; Markus (Nuremberg, DE), Yang;
Qiao (Furth, DE) |
Applicant: |
Name |
City |
State |
Country |
Type |
Siemens Healthcare GmbH |
Erlangen |
N/A |
DE |
|
|
Assignee: |
Siemens Healthcare GmbH
(Erlangen, DE)
|
Family
ID: |
1000005199611 |
Appl.
No.: |
16/163,357 |
Filed: |
October 17, 2018 |
Prior Publication Data
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|
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Document
Identifier |
Publication Date |
|
US 20190117180 A1 |
Apr 25, 2019 |
|
Foreign Application Priority Data
|
|
|
|
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Oct 19, 2017 [EP] |
|
|
17197323 |
Aug 16, 2018 [EP] |
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18189341 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
6/5241 (20130101); A61B 6/4441 (20130101); A61B
6/0487 (20200801); A61B 6/505 (20130101); A61B
6/5217 (20130101); A61B 6/542 (20130101); A61B
6/027 (20130101); A61B 6/025 (20130101); A61B
6/5205 (20130101); A61B 6/12 (20130101); A61B
5/7271 (20130101); A61B 6/54 (20130101); A61B
5/4504 (20130101) |
Current International
Class: |
A61B
5/00 (20060101); A61B 6/04 (20060101); A61B
6/02 (20060101); A61B 6/00 (20060101); A61B
6/12 (20060101) |
Field of
Search: |
;382/132 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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102006048451 |
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Apr 2008 |
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DE |
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102007034221 |
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Apr 2008 |
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DE |
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102015201067 |
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Jul 2016 |
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DE |
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102015207727 |
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Nov 2016 |
|
DE |
|
WO2009153789 |
|
Dec 2009 |
|
WO |
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Other References
European Search Report for European Patent Application No.
18189341.3-1124 dated Mar. 20, 2019. cited by applicant.
|
Primary Examiner: Bayat; Ali
Attorney, Agent or Firm: Lempia Summerfield Katz LLC
Claims
The invention claimed is:
1. A method for determining an alignment between at least two bone
parts of an elongated bone system of a patient, the method
comprising: recording, by a recording system of an x-ray device, a
plurality of partially spatially overlapping projection images
during a translational movement of the x-ray device or the
recording system in a direction of or parallel to a longitudinal
axis of the elongated bone system; reconstructing tomosynthesis
image data of the at least two bone parts from the plurality of
recorded partially spatially overlapping projection images; and
determining or estimating an alignment angle between the at least
two bone parts at least partially based on the reconstructed
tomosynthesis image data, the plurality of recorded partially
spatially overlapping projection images, or the reconstructed
tomosynthesis image data and the plurality of recorded partially
spatially overlapping projection images.
2. The method of claim 1, wherein the x-ray device is a mobile
x-ray device.
3. The method of claim 2, wherein the mobile x-ray device is a
mobile C-arm x-ray device.
4. The method of claim 1, wherein the tomosynthesis image data
comprises slice images.
5. The method of claim 1, wherein a rotational movement of the
recording system is carried out during the recording and the
translational movement of the x-ray device.
6. The method of claim 1, wherein the determining or the estimating
of the alignment angle between the at least two bone parts
comprises determining or estimating the alignment angle between the
at least two bone parts based exclusively on reconstructed
tomosynthesis image data.
7. The method of claim 1, wherein further projection images are
used in the determining or the estimating of the alignment angle
between the at least two bone parts.
8. The method of claim 1, wherein a distance between two images of
the plurality of partially spatially overlapping projection images
is constant and less than or equal to half of an object width that
is detectable by an opening angle of an x-ray source of the
recording system.
9. The method of claim 1, wherein a distance between two images of
the plurality of partially spatially overlapping projection images
differs as a function of a recording position along the elongated
bone system.
10. The method of claim 1, wherein the elongated bone system is
formed of a femur and the alignment angle of an antitorsion
angle.
11. The method of claim 1, wherein the elongated bone system is
formed of a spinal column segment, and the alignment angle is
formed of an angle between two vertebral bodies.
12. The method of claim 1, wherein the translational movement is
carried out by automatically controlled rollers of the x-ray device
along a floor.
13. The method of claim 1, wherein the translational movement is
carried out along at least one rail.
14. An x-ray recording device for determining an alignment between
at least two bone parts of an elongated bone system of a patient,
the x-ray recording device comprising: a mobile C-arm x-ray device
comprising: a recording system held on a C-arm, the recording
system comprising an x-ray source and an x-ray detector; a system
controller configured to control a recording of a plurality of
partially spatially overlapping projection images by the recording
system during a translational movement of the mobile C-arm x-ray
device; and an image processor and a calculator configured to
reconstruct tomosynthesis image data and determine an alignment
angle.
15. The x-ray recording device of claim 14, wherein the
tomosynthesis image data comprises slice images.
16. The x-ray recording device of claim 14, wherein the mobile
C-arm x-ray device further comprises a trolley that is
automatically movable on rollers, the C-arm being arranged on the
trolley.
17. The x-ray recording device of claim 15, wherein the mobile
C-arm x-ray device further comprises a trolley that is
automatically movable on rollers, the C-arm being arranged on the
trolley.
18. The method of claim 2, wherein the translational movement is
carried out by automatically controlled rollers of the mobile x-ray
device along a floor.
19. The method of claim 18, wherein the mobile x-ray device is a
mobile C-arm x-ray device.
20. The method of claim 5, wherein the translational movement is
carried out along at least one rail.
Description
This application claims the benefit of EP 17197323.3, filed on Oct.
19, 2017, and EP 18189341.3, filed on Aug. 16, 2018, which are
hereby incorporated by reference in their entirety.
BACKGROUND
The present embodiments relate to determining an alignment between
at least two bone parts of a patient.
Femur neck fractures occur relatively frequently and, in most
instances, are to be treated surgically. With this surgical
intervention, a femoral nail is generally introduced into the
femoral neck. Prior to locking the femoral nail, the antitorsion
angle is to be aligned between the distal and the proximal end of
the femur. Since the determination of the antitorsion angle during
the surgical intervention is very complicated, in most instances,
the antitorsion angle is quantified inadequately. The alignment is
determined based on instinct or by the physician comparing the
right and left foot positions. Deviations in the antitorsion angle
by +/-12.degree. are the rule. As a result of this, frequent
complaints and rapid wear of the joint surfaces (e.g., arthrosis)
result.
DE 10 2015 201 067 A1 discloses a method for determining an
antitorsion angle with simple two-dimensional x-ray images.
The following facts are also considered to be challenges when
determining the antitorsion angle: (a) The angle is to be
determined between the distal and the proximal end of the femur,
and a large field of view is therefore to be provided. The length
of the femur is approximately 50 cm in adults, for example. (b)
Since a rotation along the axis of the bone is to be determined,
simple projection images are not adequate. Previously the
determination of the angle could only be quantified with sufficient
accuracy in one volume image (MPR). (c) The alignment is to be
carried out during the surgical intervention, and as a result,
further challenges arise with respect to sterility, time
constraints, and patient immobility.
Currently, no standardized methods are known for quantifying the
antitorsion angle during an operative intervention.
SUMMARY AND DESCRIPTION
The scope of the present invention is defined solely by the
appended claims and is not affected to any degree by the statements
within this summary.
The present embodiments may obviate one or more of the drawbacks or
limitations in the related art. For example, a method that
eliminates the cited disadvantages is provided. As another example,
an x-ray recording apparatus suited to carrying out the method is
provided.
The method of one or more of the present embodiments for
determining an alignment between at least two bone parts of an
elongated bone system of a patient includes recording a plurality
of partially spatially overlapping projection images by a recording
system of an x-ray device (e.g., a mobile x-ray device) during a
translational movement of the x-ray device or the recording system
in a direction of or parallel to a longitudinal axis of the bone
system. Tomosynthesis image data (e.g., slice images) of the bone
parts is reconstructed from the recorded projection images, and an
alignment angle between the at least two bone parts is determined
or estimated at least partially with the aid of the projection
images or the reconstructed tomosynthesis image data.
The method of one or more of the present embodiments eliminates the
problems that occur when an alignment angle (e.g., antitorsion
angle) of an elongated bone system (e.g., femur) is determined. The
translational movement of the mobile x-ray device allows a
particularly "long" field of view to be mapped. The length of the
slice volume resulting, if required, may be determined, if
required, by the length of the path traveled. This length may be
defined by the operating physician, for example. The tomosynthesis
enables not only two-dimensional images to be recorded, but also
allows three-dimensional slice images or three-dimensional partial
images (e.g., volume representations) to be recorded and
reconstructed. Using these three-dimensional slice images or
partial images, quantification of the alignment angle (e.g.,
antitorsion angle) is easily possible and with good quality. For
example, a mobile x-ray device may also be used in a sterile
environment (e.g., during an operation). The translational movement
of the mobile x-ray device may be achieved by a very quick, simple,
and low-cost workflow. The requisite dose of radiation is
significantly lower for a tomosynthesis recording than for
conventional volume scans such as CT or DynaCT.
Using the method, the antitorsion angle may be determined during a
surgical intervention, for example, before a requisite femoral nail
is locked, so that a correction is enabled when an inconsistent
antitorsion angle is defined. Within the scope of the correction,
the distal and the proximal end of the femur may then be aligned
more accurately with respect to one another. The correction option
results in improved operation results and fewer complications and
complaints from the patient.
The determination or estimation of the alignment angle is carried
out at least partially based on reconstructed tomosynthesis image
data (e.g., of a reconstructed slice image or reconstructed partial
images or image cutouts). In the presence of a slice image or
partial images or image cutouts that are registered with respect to
one another, two bone parts of the elongated bone system may be
identified by segmentation or object recognition. Subsequently, the
alignment angle occurring between the two bone parts may be
determined or estimated, for example, by applying axes or tangents
to the relevant structures of the at least two bone parts. The
result may then be output by a display apparatus, for example. The
antitorsion angle is the angle between the femoral neck and the
femoral condyle (e.g., more precisely, the angle that is formed by
a femoral neck axis and a femoral condyle tangent). In the presence
of a three-dimensional slice image, such as is produced in the
present method, the antitorsion angle may be easily determined.
Alternatively to a femur and an antitorsion angle, the elongated
bone system involving a spinal column segment and the alignment
angle may also be formed by an angle between two vertebral bodies.
Spinal column injuries occur in almost 28% of all severely injured
patients in Germany. Considered statistically, the lower cervical
vertebra is affected in every 6th patient. Since these
interventions are very challenging, during the intervention, the
surgeon is reliant on imaging methods. However, the intraoperative
2D imaging such as the conventional radiography in the
cervicothoracic region is limited on account of significant
overlapping of the shoulders, and an adequately precise
representation of a repositioning result of the spinal column is
only possible with a 3D imaging. All problems may also be easily
resolved by, for example, the method of one or more of the present
embodiments. The elongated region of interest as a
three-dimensional slice image or cutouts therefrom may be shown
quickly and easily in the operating room as 3D partial images,
where the radiation exposure to the patient remains minimal. If a
non-optimal angle between, for example, two spinal columns is
determined or defined, a further intervention may be carried out
for correction purposes.
According to a further embodiment, the alignment angle between the
at least two bone parts is determined or estimated exclusively
based on reconstructed tomosynthesis image data (e.g., slice
images).
According to a further embodiment, further projection images from
different projection directions (e.g., lateral projection images)
are used to determine or estimate the alignment angle between the
at least two bone parts.
According to a further embodiment, a rotational movement of the
recording system is additionally carried out during the recording
and the translational movement of the x-ray device. The 3D imaging
may be improved significantly by this. A rotation of, for example,
60.degree. (e.g., rotational angle of +30.degree. to -30.degree.)
may be provided here.
According to one embodiment, the distance between two images of the
plurality of partially spatially overlapping images is constant and
smaller than or equal to half of the object width (d') that may be
detected by an opening angle .alpha. of an x-ray source of the
recording system. A consistent image quality of the slice images is
achieved across the entire recorded length by the constant
distance. A distance of less than or equal to half of the
detectable object width d' supplies sufficient depth information
for a high-quality three-dimensional slice image. The detectable
object width d' is the cutout from the elongated bone system that
may be projected at most onto the actual detector width d of the
x-ray detector of the recording system. The relation
'.times..times..times..times..times..times..times..times..times.
##EQU00001## is valid, where source object distance (SOD) is the
distance between the object and the x-ray source and source image
distance (SID) is the distance between the x-ray source and the
x-ray detector of the recording system.
According to a further embodiment, the distance between each two
images of the plurality of partially spatially overlapping images
differs as a function of a recording position along the elongated
bone system. Provision may be made in the case of a femur, for
example, for the distance in the central region of the elongated
bone system (e.g., the femoral shaft) to be higher and the image
quality to thus be lower, since no relevant regions are present for
the determination of the antitorsion angle. Provision may also be
made with other elongated bone systems for the distance in the
region of a fracture or in the contact region of the two bone parts
to be smaller and a higher image quality therefore to be achieved
there.
According to a further embodiment, the translational movement is
carried out by, for example, automatically controlled rollers of
the mobile x-ray device along a floor. The motorized rollers or
wheels may be controlled by the system controller. Alternatively, a
fixedly installed x-ray device may be moved on rails, or only the
recording system (e.g., C-arm) of a fixedly installed x-ray device
may be moved translationally on suspension.
One or more of the present embodiments include an x-ray recording
apparatus for carrying out the method. The x-ray recording
apparatus is configured as a mobile C-arm x-ray device having a
recording system that is held on a C-arm with an x-ray source and
an x-ray detector. A system controller controls the recording of a
plurality of partially spatially overlapping images (e.g.,
tomosynthesis image data) by the recording system during a
translational movement of the recording system of the x-ray device.
An image processing unit (e.g., an image processor) and a
calculation unit (e.g., a calculator; the image processor or
another processor) reconstructs slice images and determines the
alignment angle. The x-ray recording apparatus has a trolley that
may move automatically on rollers and on which the C-arm is
arranged.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 shows a known recording system for recording a femoral
cutout;
FIG. 2 shows a sectional view of a known antitorsion angle;
FIG. 3 shows a top view of a known antitorsion angle;
FIG. 4 shows one embodiment of a recording system for recording a
plurality of partially spatially overlapping images for displaying
a femur;
FIG. 5 shows an enlarged view of the recording geometry according
to FIG. 4 with three different projection directions for
reconstructing a slice image;
FIG. 6 shows a further view of the recording geometry according to
FIG. 4;
FIG. 7 shows one embodiment of a recording system for recording a
plurality of partially spatially overlapping images for the purpose
of displaying a spinal column;
FIG. 8 shows one embodiment of a mobile C-arm x-ray device;
FIG. 9 shows a series of acts of one embodiment of a method;
and
FIG. 10 shows one embodiment of a recording system with
simultaneous translational and rotational movements.
DETAILED DESCRIPTION
A known recording system with an x-ray detector 2 and an x-ray
source 3 for recording a two-dimensional x-ray image of a femur is
shown in FIG. 1. It is possible determine an antitorsion angle
after a fracture and during an OP for correcting the femur 6 to a
very limited extent using an image of this type. A volume may be
acquired at a distal end of the femur, and a volume may be acquired
at a proximal end of the femur with the aid of mobile 3D-capable
x-ray devices. Based on the complex workflow and the high radiation
dose applied, this is not carried out, however, and would also not
result in an optimal determination of the antitorsion angle, since
two independent volumes are to be evaluated.
A known antitorsion angle 13 is shown as a sectional image and as a
top view in FIGS. 2 and 3, respectively. This is the angle between
the femoral neck 14 and the femoral condyle 15 (e.g., more
precisely, the angle that is formed by the femoral neck axis 7 and
the femoral condyle tangent 19). Following a fracture of the femur
6 and an incomplete correction, the femoral neck 14 and the femoral
condyle 15 are frequently arranged twisted toward each other along
the femoral shaft axis 16 of the femoral shaft 17.
FIG. 4 shows a recording system for recording a plurality of
partially spatially overlapping images for displaying a femur. For
this purpose, the recording system is moved essentially in a
direction 4 of the elongated bone system (e.g., the femoral shaft
axis of the femur) or parallel hereto in a translational movement,
and x-ray images are recorded at generally regular intervals during
the movement of the recording system. The sequence of movement is
shown as, for example, a plurality of x-ray source 3-x-ray detector
2 combinations. In the positions shown, the respective x-ray images
are recorded. The source distance s is the distance between two
x-ray images. On the assumption that the source object distance
(SOD) (e.g., distance between the x-ray source and the recording
object; elongated bone system) remains constant along the traveled
trajectory, the detectable object width corresponds to
d'=d*SOD/SID, where d is the actual detector width, for a specific
source-image distance (SID) (e.g., distance between x-ray detector
and x-ray source).
A cutout from the diagram in FIG. 4 is shown in FIG. 5, where the
geometry of three successive x-ray images is shown. On account of
the geometry, spatial points 7 that are fully passed over are shown
in the x-ray images from different projection directions. This may
be used to reconstruct a slice image of the completely passed-over
region with the aid of a tomosynthesis method. In a first position
A of the recording system, the spatial point 7 is mapped from the
first projection direction R.sub.A; in a second position B of the
recording system, the spatial point 7 is mapped from the second
projection direction R.sub.B; and in a third position C of the
recording system, the spatial point 7 is mapped from the third
projection direction R.sub.C. This is used to reconstruct a slice
image with the aid of a tomosynthesis method.
In order to obtain depth information from two-dimensional x-ray
images, the relevant anatomical positions are to be shown on at
least two x-ray images. Consequently, the source distance s between
two x-ray recordings are to be less than or equal to half of the
detectable object width d' (see FIG. 6). In this case, the angle
.beta. between two projection directions with .beta..apprxeq.1/2
may be approached, where .alpha. corresponds to the opening angle
of the x-ray source, and tan .alpha.=d/SID also applies.
The accuracy of the antitorsion angle determination depends
significantly on how precisely 3D information may be determined
from the x-ray images. An erroneous displacement .DELTA. within the
image plane with an effect of .DELTA./tan .beta. is included in the
estimation of the distance between the x-ray source and examination
object (SOD). Therefore, with small opening angles, care is to be
taken to provide that the angle .beta. is maximized in order to
improve the accuracy of the antitorsion angle determination.
With a source distance between the recordings of
.function..times..times.' ##EQU00002## the angle .beta. between the
projection directions corresponds to
.beta..function..apprxeq..alpha..function. ##EQU00003## where n is
the number of projection directions per spatial point. In other
words, the maximum angle between the projections approaches .alpha.
with an increasing n. With an adequate SNR of the x-ray images,
n>3 is not necessarily useful for the determination of the
antitorsion angle since the increase in .beta. is still only small
.beta.(3).apprxeq.0.9.alpha..
According to a further embodiment, the distance between two images
of the plurality of partially spatially overlapping images differs
as a function of a recording position along the elongated bone
system. Provision may be made in the case of a femur, for example,
for the distance in the central region of the femoral shaft to be
higher and for a lower image quality thus to be achievable there.
This adaptive sampling may be carried out in order to save on
dosages. No anatomical structures that are relevant for determining
the antitorsion angle are located in the region of the shaft. The
distance between the x-ray images may be reduced to s(1)=1/2 d'.
With other elongated bone systems, relevant regions may likewise be
recorded with a particularly high quality (e.g., small distance),
and less relevant regions may be recorded with a lower quality
(e.g., greater distance).
For further dose reduction, the regions that do not belong to the
femur may be blended out by a collimator.
A representation of the spinal column is shown in FIG. 7 as a
further application example. A large part 5 of a spinal column may
be shown by the method, and an angle between two vertebral bodies
may be determined. On account of the significant overlapping of the
shoulder region in the cervicothoracic transition, a sufficiently
accurate display of a repositioning result during an OP of the
spinal column is only possible with 3D imaging. With the known 3D
scan, the x-ray apparatus is to move around the patient. The method
of one or more of the present embodiments allows for easy
inspection of the repositioning result by mapping the spinal column
alignment in the sagittal plane. The method allows for an exact
mapping of a slice present in the depth irrespective of overlapping
structures such as, for example, the shoulders. Compared with the
known 3D scan, the technology is faster, may be integrated better
on account of absent orbital rotation, and requires less radiation
exposure. If necessary, the entire spinal column may be mapped
together. By selecting the correct slice (e.g., slice position and
slice thickness), the spinal column may be shown isolated from
overlapping objects (e.g., the shoulder region).
A mobile C-arm x-ray device 21 suited hereto is shown in FIG. 8.
The mobile C-arm x-ray device 21 has a C-arm 20 that holds an x-ray
source 3 and an x-ray detector 2. These form the recording system.
The mobile C-arm x-ray system 21 has a trolley 22 that may be moved
on rollers 23 and on which the C-arm 20 is arranged. The rollers 23
may be controlled and may be moved in a motorized manner (e.g.,
with a defined speed in a defined direction). The C-arm x-ray
device 21 is controlled by a system controller 24. This may
control, for example, a recording of a plurality of partially
spatially overlapping x-ray images (e.g., tomosynthesis image
data), while the mobile C-arm x-ray device 21 moves in a defined
translational movement by the trolley 22. Moreover, the C-arm x-ray
system has an image processing unit 25 for processing x-ray images
and a calculation unit 26 for reconstructing slice images from the
plurality of x-ray images and for determining the alignment angle
from the slice images. Such a C-arm x-ray device 21 may be used in
a sterile environment and during a surgical intervention.
The elongated bone system (e.g., femur) is arranged as close as is
compatible with patient safety on the x-ray detector 2.
FIG. 9 shows a sequence of acts of the method according to one or
more of the present embodiments. In act 10, a plurality of
partially spatially overlapping x-ray images are recorded, while
the recording system (e.g., x-ray source and x-ray detector or
C-arm holding the same) of the, for example, mobile C-arm x-ray
device 21 is moved in a translational movement in the direction of
or parallel to the longitudinal axis of the elongated bone system
(e.g., femur or spinal column). In the case of the mobile C-arm
x-ray device, the complete C-arm x-ray device moves forward on the
trolley by the automatically controlled rollers in a defined
translational movement such that the source distance s between each
two images is less than or equal to half of the detector width of
the x-ray detector. On account of the x-ray source-x-ray detector
geometry (e.g., expanding x-ray beam), in such cases, the spatial
points 7 passed over completely are shown in the plurality of x-ray
images from different projection directions. It is accordingly
advantageous to record the respective individual x-ray images in as
short a time as possible (e.g., in less than 5 ms per x-ray image),
so that as little smearing as possible results.
Alternatively, a non-mobile C-arm x-ray device may also be moved on
rails, or only the recording system (e.g., C-arm) of a fixedly
installed x-ray device may be moved.
In act 11, a three-dimensional slice image of the bone parts of the
elongated bone system (e.g., the entire femur of a patient) is
reconstructed from the recorded partially spatially overlapping
x-ray images, for example. Alternatively, only 3D partial images or
cutouts from images may also be reconstructed (e.g., only the
femoral head and/or the femoral condyle). In act 12, an alignment
angle between the at least two bone parts is determined or
estimated at least partially based on the reconstructed slice
image/images or the partial images or the projection images. Since
a complete slice image of the entire elongated bone system may be
produced by the tomosynthesis method, the geometric relations of
the bone system may be easily derived from this one volume image
(e.g., by applying straight lines and tangents to the relevant
structures and/or using segmentations and/or image recognition
algorithms).
The method of one or more of the present embodiments allows the
antitorsion angle to be determined during a surgical intervention
(e.g., before the femoral nail is locked). The method is
characterized by a simple workflow within a sterile environment, a
freely definable field of view along the direction of movement, and
resulting slice images for determining, for example, the
antitorsion angle. By determining the antitorsion angle, the distal
end and the proximal end of the femur may be aligned more precisely
with respect to one another. This results in fewer complications
and complaints from the patient.
The method of one or more of the present embodiments is also
advantageous in that on account of the translational movement, the
workflow for the image acquisition is very simple. The complexity
for the user (e.g., a physician carrying out a surgical
intervention) is reduced since the physician is able to quantify
the alignment angle (e.g., antitorsion angle) based on a complete
volume and does not require two or more volume images produced
independently of one another for this purpose. In addition, the
applied radiation dose is significantly lower for a tomosynthesis
scan than, for example, for two 3D recordings.
A method is shown as a further exemplary embodiment in FIG. 10, in
which in addition to translation a rotation of the C-arm is also
carried out in order to determine an antitorsion angle. The
workflow associated therewith is described below. The leg of the
patient should not be moved during the entire workflow.
In a first part of the workflow, the orientation of the distal end
of the femur is sought. The C-arm is arranged laterally (not
shown), and a manual attempt is made per fluoroscopy to find a
projection view, in which the central and the lateral condyle are
arranged one behind the other along the x-ray beam and form a
shared lower edge. The lower edge is then determined manually. The
orientation and the height of the distal end of the femur or
femoral condyle tangent are calculated herefrom.
The second and third part of the workflow are formed by an
embodiment of the method.
The C-arm 20 is positioned in the second part of the workflow such
that the C-arm 20 carries out a translation in the direction 4
along the femur 6 (e.g., including femoral head and large
trochanter). The C-arm 20 is tilted about an angle of rotation
.gamma. (e.g., about -30.degree. or as far as possible without
colliding with the patient). While recording the plurality of
projection images at a high frequency, the C-arm 20 is translated
in the direction 4 of the axis of the elongated femur 6 and is
rotated at the same time in the process (e.g., between the angles
of rotation of +30.degree. and -30.degree.; over an angular
increment of 60.degree.) or between the maximum and the minimum
possible angles of rotation .gamma. (e.g., this may also change
during the translation, the angular increment, fluctuate between
60.degree. and 78.degree.). The relation between rotation and
translation is calculated or detected. For example, the femoral
head and the large trochanter are scanned such that the entire
femur may also be scanned.
The reconstruction and calculation of the antitorsion angle is
carried out in the third part of the workflow. A 3D partial image
of the surface of the femoral head and of the large trochanter is
reconstructed based on the plurality of recorded projection images.
The orientation of the femoral neck axis is determined based on
this image data. The antitorsion angle is then produced from the
difference between the orientations of the femoral neck axis and
the previously determined femoral condyle tangent.
The present embodiments include a method for determining an
alignment between at least two bone parts of an elongated bone
system of a patient. The method includes recording a plurality of
partially spatially overlapping projection images by a recording
system of an x-ray device (e.g., a mobile x-ray device) during a
translational movement of the x-ray device or of the recording
system in a direction of or parallel to a longitudinal axis of the
bone system. Tomosynthesis image data (e.g., slice images), of the
bone parts is reconstructed from the recorded projection images,
and an alignment angle is determined or estimated between the at
least two bone parts at least partially based on the reconstructed
tomosynthesis image data and/or the projection images.
The elements and features recited in the appended claims may be
combined in different ways to produce new claims that likewise fall
within the scope of the present invention. Thus, whereas the
dependent claims appended below depend from only a single
independent or dependent claim, it is to be understood that these
dependent claims may, alternatively, be made to depend in the
alternative from any preceding or following claim, whether
independent or dependent. Such new combinations are to be
understood as forming a part of the present specification.
While the present invention has been described above by reference
to various embodiments, it should be understood that many changes
and modifications can be made to the described embodiments. It is
therefore intended that the foregoing description be regarded as
illustrative rather than limiting, and that it be understood that
all equivalents and/or combinations of embodiments are intended to
be included in this description.
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